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Old 10-01-2011
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Drug What drug to give while awaiting angiography!

A patient is hospitalized and waiting for coronary angiography. His history includes angina pectoris that is brought on by "modest" exercise, and is accompanied by transient electrocardiographic changes consistent with myocardial ischemia. There is no evidence of coronary vasospasm. In the hospital he is receiving nitroglycerin and morphine (slow intravenous infusions), plus oxygen via nasal cannula.
He suddenly develops episodes of chest discomfort. Heart rate during these episodes rises to 170–190 beats/min; blood pressure reaches 180–200/110–120 mm Hg, and prominent findings on the EKG are runs of ventricular ectopic beats that terminate spontaneously, plus ST-segment elevation.
Although there are several things that need to be done for immediate care, administration of which one of the following is most likely to remedy (at least temporarily) the majority of these signs and symptoms and pose the lowest risk of doing further harm?

A. Aspirin
B. Captopril
C. Furosemide
D. Labetalol
E. Lidocaine
F. Nitroglycerin (increased dose as a bolus)
G. Prazosin
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Old 10-01-2011
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E. Lidocaine
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Old 10-01-2011
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E. Lidocaine
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Yes its Lidocaine
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Old 10-01-2011
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Correct Answer

Lidocaine is correct.
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But why HTN?
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Old 10-04-2011
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Labetalol is the best choice. .)
Aspirin will do no harm in this situation, but it will also do no good acutely unless there is ongoing platelet aggregation and coronary occlusion. Even if there were, the aspirin would do little to control heart rate, blood pressure, or the EKG changes.
Nothing in the scenario suggests this patient is volume-overloaded or suffering acute pulmonary edema. Therefore, administering the furosemide in such a situation is not appropriate. Moreover, giving it is likely to cause prompt reductions of blood volume and, along with it, of blood pressure. The latter effect is likely to lead to further—and unwanted—reflex sympathetic activation that would make matters worse.
Lidocaine might be suitable for the ventricular ectopy. However, we have identified several other important signs and symptoms that would not be relieved by this antiarrhythmic drug. As noted above, the profile of labetalol offers the greatest likelihood of managing multiple problems with one drug.
Increasing the dose of nitroglycerin (and especially giving it as a bolus) is likely to drop blood pressure acutely, triggering reflex (baroreceptor) stimulation of the heart. The usual "anti-ischemic" effects of the drug would be counteracted by such "pro-ischemic" changes as further rises of heart rate and a probable worsening of the premature ventricular beats.
Prazosin would lower blood pressure nicely. However, once again we have to worry about excessive pressure lowering, triggering the baroreceptor reflex, and worsening many of the already worrisome findings (e.g., heart rate, PVCs).
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